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Patient/Family Education Print Material Guidelines The best form of health education is always a careful two-way conversation between the patient and the health professional. Print materials are tools that should be available to the health professional and the patient to support this education. When used effectively, print materials can assist health care professionals to maximize limited teaching time and enable patients to better manage their health. Paul, Redman & Sanson-Fisher (2003) write that the provision of educational information (most often in print form) is considered to be a fundamental prerequisite of consumer participation in health care. It is important to remember that print materials are only a resource to assist in the overall educational plan. Mansour and Dowse (2003) make the point that as patients retain only 20% of what they hear, this combination of oral information from a health care professional plus written information should improve patients’ knowledge, confidence, increase their participation in health care decisions and increase adherence to the treatment plan. McClune, Burton & Waddell (2003) support the view that patient information improves care. It is essential that Capital Health provide quality materials to patients to encourage consumer participation and improve care. Capital Health will provide patients and families with appropriate, comprehensive, easy to use, and helpful information resources. The materials are to have interdisciplinary and District input, a standard format, and be sensitive to cultural diversity. Please keep in mind Capital Health’s core values of collaboration, accountability, respect and excellence when developing patient and family education materials. The Patient/Family Education Print Material Guidelines document was created to provide a process to follow in the development of patient/family education print materials. Please contact the Patient Education Coordinator if you have suggestions to improve this document. To locate an electronic version of this document, go to the Capital Health Intranet, select For Employees, then, Quick Links/Documents and click on Patient Teaching Pamphlets. All patient education print materials will be placed on the Capital Health Website after they have been: • approved by the Division Head/Clinical Leader or Delegate for clinical accuracy. • approved by the Patient Education Coordinator for patient education standards. • prepared by a graphic designer. Contact Person: Patient Education Coordinator, Capital Health, Halifax, Nova Scotia. 1


Table of Contents Introduction ............................................................................................................... 3 Developing Print Materials ....................................................................................... 4 Getting Started....................................................................................................... 4 Criteria for Development ........................................................................................ 5 Selecting a Simpler Word ....................................................................................... 10 Check List for Developer (Form 1) .......................................................................... 12 Recommended Outlines ......................................................................................... 14 SMOG Readability Formula..................................................................................... 19 Flesch Kincaid Reading Level .................................................................................. 20 Approval .................................................................................................................... 21 Maintenance and Review Process ........................................................................... 21 Patient/Family Education Print Material, Approval Record (Form 2) ........................ 25 Consumer’s Evaluation of Pamphlet (Form 3) ......................................................... 26 Catalogue................................................................................................................... 28 Maintenance (prepared in-house)........................................................................... 28 Recommendations for Materials (from outside sources) .......................................... 30 Catalogue Template, Materials (from outside sources) ............................................ 31 CH Pamphlets on the CH Public Website .................................................................. 32 Evaluation of Collaboration with Patient Education Coordinator (Form 4) ............ 33 Reviewing and Updating Pamphlets ......................................................................... 35 Keeping Patient/Family Pamphlet Print Materials Updated in Clinical Areas ......... 36 Bibliography .............................................................................................................. 37 2


Introduction Writing Quality Patient/Family Education Print Materials The need for quality patient/family education has become greater due to the increasing complexity of care, shorter hospital stays and a shift towards outpatient care. Print materials can be valuable tools for patient education but they are only supplements and never a substitute for verbal communication. Print materials can convey basic repetitive information freeing the health care professional to concentrate on individualized follow-up instruction. They can also enable consistency in teaching by a diverse group of health care professionals. Limited literacy is a widespread but often hidden problem. The ABC Canada Literacy Foundation Report Summary November 2005 found that 48% of Canadian adults age 16 and over have low literacy. This has not changed since 1994 and must be given consideration when we evaluate and prepare print material for our patients and their families. It should be noted that most people read at least two grade levels below their last school grade completed, (London, 1999, p189) so relying on the length of formal education as an assessment parameter is a serious limitation. A great deal of available patient/family education material is highly technical, is written at the high school or university level, and as a result often fails to accomplish the goal of providing understandable material. A readability formula should be used to predict the level of reading skills needed to read a piece of material. These skills are expressed as a grade level and we must target the grade level of our patient/family education print material at grade six or below. A formula is a quick guide but it provides only a rough estimate of readability and is not a substitute for common sense. Computer software programs are available to assist us but they also give only an estimate of readability. A low reading level is only one of many elements that makes a piece of material easy to understand. If our patients are to benefit from printed health information, the materials must be written clearly and concisely. Clear writing includes logical organization and familiar language, which sounds like every-day speech. Other topics to be considered when preparing and evaluating the readability of material is the overall appearance, sentence length and tone. It is imperative that health care professionals develop creative, innovative and comprehensive patient/family education materials. The Patient Education Coordinator is available for consultation with individuals or groups who would like to discuss the general principles of preparing materials or to collaborate on a specific piece of patient education material.

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Developing Print Materials Partin et al. (2004) note that pamphlet and video interventions are comparable in effectiveness hence the lower cost pamphlet approach is an attractive option when resources are limited.

Getting Started • Develop a work-group and appoint a leader. • Contact the Patient Education Coordinator who will act as a resource and provide assistance. • Ask the Patient Education Coordinator to attend work-group meetings (as needed). The Patient Education Coordinator will familiarize the work group with Patient/Family Education Print Material Guidelines. • Develop a plan following criteria and process in Patient/Family Education Print Material Guidelines.

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Developing Print Materials Criteria for Development 1.0 Clinical Department/Group Developing Pamphlet 1.1 Organization • The opening paragraph states the purpose of the pamphlet. • Title reflects content. • Question & Answer format is useful. • Headings and subheadings are required. • A glossary is important and should be placed at the beginning rather than at the end of a pamphlet so the reader is more likely to find and use it. • A table of contents is not necessary if the pamphlet is less than 8 pages - do not count the title page.

1.2 Style & Language • Use a friendly tone. • Promote patient taking an active role in his/her learning. • Promote patient taking an active role in his/her health. • Talk directly to the reader. Use the words: you, I, we, us and our to make the material more personal. Do not refer to your reading audience as clients, patients or customers. • Use gender free language. • Be sensitive to the cultural values and beliefs of diverse communities. • Place the subject and verb close to the beginning of the sentence. • Eliminate all unnecessary words. • Be consistent with the terms you use throughout the document. • Use 1 or 2 syllable words as much as possible. • Maintain average sentence length of 10 words. • Limit paragraphs to 4 or 5 sentences. • List information whenever possible.

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1.3 Illustrations • Consult with the graphic designer in the Audio Visual Department regarding illustrations. Limited clip art is available from the designer. • Use only illustrations that do not have copyright or obtain written permission to use from owner. The Patient Education Coordinator will provide assistance. Submit written copyright permission with draft to the Patient Education Coordinator. • Use simple line drawings. • When using line drawings of anatomy, include body landmarks. • Ensure that illustrations are to up-to-date. • Label diagrams with familiar words. • Try to include pictures that represent various ethnic groups, both men and women equally and avoid stereotypical occupational roles. • To prevent patients from mistaking a “Do Not” drawing for a “Do”, use the familiar heavy slash through the diagram. • Use some illustrations or graphics as they provide relief from dense text.

1.4 Readability • Unless it is necessary for the reader to learn medical words, there is no reason why simple language should not be used. • Define all medical terms. • Target the reading level to grade six or below. • Use a readability formula. SMOG is a good choice (See page 19 & 20). • The first time an acronym is used, it should appear with the words it represents. • Use dark type (navy or black) on white or cream background. • Avoid glossy paper. • Do not use Roman numerals. • Do not use abbreviations. • Do not hyphenate words over two lines. • Ensure that text is not too dense.

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1.5 Other • Be prepared to go through several drafts. • Remember your readers’ cultural, ethnic, economic and educational backgrounds. • Contact the Capital Health Ethics Support (CHES) Ethics Education if a pamphlet contains ethics content. See the CH Intranet site under Capital Health Ethics Support for more information. • Create your own (text) content. Materials developed outside Capital Health are to be used only as a resource. • Develop and maintain a bibliography of sources used in the development of the pamphlet. Do not include these in the pamphlet.

2.0 Graphic Designer 2.1 Visual Appearance • DO NOT USE ALL UPPER CASE LETTERS • Do not use different type faces on the same page. • Use a print font that is 14 point in the body text. In special circumstances 18 point may be best. • Use Adobe Granjon or Adobe TradeGothic font. • Use a justified left margin and a ragged right margin. • Use generous amounts of white space (areas without print). • Use wide margins and borders. • Use bullets instead of long paragraphs. • Skip at least one line between paragraphs and sections. • Use one of the standard, pre-printed covers. • Emphasize important information remembering that too much emphasis can be distracting.

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2.2 Other • Include the name of the developer with credentials, unit or department, on the back cover of each pamphlet. • Only the developer can revise a pamphlet. Anyone who identifies that a pamphlet needs updating is to contact and then collaborate with the developer to update the educational piece. • Pamphlet size will be 8 1/2 x 11 inch or 8 1/2 x 5 1/2 inch or 8 1/2 x 11 two-fold. • Page numbers are to be placed on the pamphlet if it is more than one folded page. • Include the year of revision and the Capital Health logo on the front of each pamphlet. • Place a Print Shop order number on each pamphlet and ensure that this is entered into the catalogue. • Place the development or revision month and year on the back of each pamphlet. • Include the hospital smoking and scent policy on the pamphlet. • Promote HRM Library Services on the back cover of each pamphlet with the following statements. Looking for more health information? Contact your local public library for books, videos, magazine articles, and online health information. For a list of public libraries in Nova Scotia go to http://publiclibraries.ns.ca • Capital Health’s public website is to be placed on the back of each pamphlet.

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3. 0 Health care providers using the pamphlets 3.1 Printing • Use pamphlets printed from a master in the Print Shop. Do not photocopy. • Order limited numbers from the Print Shop. An order can be as small as only 15 copies. This may help to prevent waste as pamphlets are updated regularly. • Print a pamphlet from the website when a topic is rarely needed. • Assign one staff person to order the pamphlets and maintain the pamphlet racks.

3.2 Displaying Materials • Placing patient information racks in high-traffic areas is an ideal way for patients and families to readily access and take information that is relevant to them. • The year that the pamphlet is developed or revised is to be placed on the front cover so it can be easily seen when the pamphlet is displayed in a pamphlet rack.

4. 0 Translation • To ensure the quality of translation, it must be done by a professional, certified translator. • Do not use online translation tools and/or computer software.

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Selecting a Simpler Word Complex

Simple

Complex

Simple

Abdomen Ability Accompany Accomplish Acetaminophen Achilles tendon Acidosis Acne Acquire Adequate Administer Advise Aggravate Alternative Ambulate Analgesic Annually Anticipate Appears Apply Approximately Ascertain Assist At the present time Attempt Available Bacteria Benefit Cessation Choose Close proximity Commence Complete Comply Components Conclude Consult Contraceptive Contact Contains Contusion

Stomach area Skill Go with Do, carry out e.g. Tylenol速 / Tempra速 Heel cord Too much blood acid Red pimples Gain, get Enough Give Tell, recommend Make worse, worsen Choice Walk Pain reliever Yearly Expect Seems Put on, use About Find out Help Now Try Ready Germs Help Stop, pause Pick Near Begin Finish, fill out Do, follow Parts End, finish Ask Birth control Call Has Bruise

Demonstrate Detect Decrease Determine Difficulty Discolouration Discontinue Discover Discuss Dressing Due to the fact that Effect Elevate Eliminate Endeavor Ensure Epidermis Excessive Experience Facilitate Failed to Frequently Fundamental Furthermore Hazardous Hematoma However Ibuprofen Identical Indicate Impair Implement In addition In an effort to In the event that In the near future Inadvisable Incision Incorrect Indicate Indication

Show, explain Find, notice Lessen, reduce Find out Problem, trouble Change in colour Stop Learn, find out, see Talk about, speak with Bandage, covering Because Result, bring about Raise, lift (up) Reduce, remove, cut out Try, attempt Make sure Skin Too much Feel, have Help, aid, assist Did not Often Basic, important Also Unsafe, harmful, risky Bruise But, yet, still e.g. Advil速, Motrin速 Same, alike, equal Show Harm, make worse Carry out Also To If Soon Unwise Cut, opening Wrong Show Sign

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Selecting a Simpler Word cont’d Complex

Simple

Complex

Simple

Inform Ingest Initial Injection Insufficient Intention Interrupt Laceration Locate Location Maintain Medication Minimal Modify Monitor Negative Notify Observe Obtain Optimum Option Permit Persuade Physician Place Prior (to) Present

Tell Eat First Shot, needle Not enough Aim Stop Cut, tear Find Place Keep, support Medicine, pills Least Change, revise, adjust Check, watch No, harmful Tell Watch, see, note Get, find Best Choice Allow, let Convince Doctor Put, rest, lay Before, earlier Give

Presently Provide Provided that Purchase Receive Recuperate Regarding Rehabilitate Relating to Remainder Remove Request Require Requires Retain Reveal Review Ruptured Sensation Similar Sufficient Sutures Therapy Torn ligament Unnecessary Utilize

Now Give, offer If Buy Get Get better, get well About Recover, restore About, on Rest of Take out Ask Need Asks, calls for, needs Keep Show Check, go over Burst Feeling Like Enough Stitches Treatment Sprain Needless, not needed Use

From: Calgary Health Region, Developing Patient/Client Information, 2005 Used with Permission Jan 2007.

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Developing Print Material Check List for Developer Form 1 Title: ________________________ Date: ________________________

Developer: ________________________ Department: ______________________

Did you follow the Criteria for the Development of Patient/Family Education Print Material (pages 5-8) when you developed this teaching aid? Yes No ___ Clinical Assessment

Agree

Information is current & accurate Information is sufficient for purpose Educational Assessment Maintains interest and attention Organization of information is appropriate Technical terms or acronyms are identified Reading level is grade 6 or below. If not, what grade? Is there any unnecessary information? Technical Assessment Illustrations are simple and easy to understand Illustrations promote the text Headings are used Main points stand out clearly Sentences are 10 words or less Paragraphs are short and simple (4-5 sentences) Information is listed when possible Print font is 14 point or greater All upper case letters are not used White space used to minimize concentration of text Dark type is used on white or light background 12

Disagree


Affective Assessment

Agree

Disagree

Overall appearance is appealing Tone is positive Stereotyping is avoided Commercial product promotion is not used Will this pamphlet be used by a patient independently, or should its use be guided by a health care professional? Independent Use ______ Guided Use ______ Was the draft evaluated by 3 patients? Yes ______

No ______

Has the bibliography been developed? It is to be on file with the developer. Yes ______ No ______ Stakeholders Name/Title

Department

Response Yes No Yes No Yes No Yes No

Comments

Were the issues of all stakeholder incorporated into this document? Yes _____ No _____ If no, what concerns were not included? Reviewed by the following Committees CH Patient Education Resources Advisory Committee

Yes _____ No _____

Legal Services They should review any policy, procedure, guideline or protocol Yes _____ No _____ that addresses legal, ethical, and/or patient rights issues. (If unsure, please contact Legal Services for direction). Ethics Support This Committee should review materials that have significant Yes _____ No _____ ethics content, may have an impact on autonomous choice, social justice, liberty, dignity, confidentiality/and privacy. Other Yes _____ No _____ Has the signed Patient/Family Education Print Material, Approval Record (Form 2) page 25 been submitted to the Patient Education Coordinator? Yes _____ No _____ 13


Developing Print Material Recommended Outlines Please consider the topics listed on the left under Content to ensure that all the important topics are included in the pamphlet you are developing. It is necessary to use headings and subheadings to divide your information into different topics. The column on the right provides potential titles for the various sections.

1. Diagnostic Tests/Procedures Content

Headings/Subheadings

• Definition and purpose of test

• • • • • • • •

• General information about test Provide phone number for additional information • Potential risks of test • Preparation - day before test - parking - day of test - include information re medications • Describe test • Instructions after test

• • • •

What is a __________________? Why is this test done? Who will do the test? Where will the test be done? How long will the test take? Are there any risks with this test? How do I get ready for the test? Where will I park?

How is the test done? Care at home Call your doctor if you have: If your doctor is not available go to the nearest Emergency Department. • Visit to your doctor/other health care professionals.

• Follow-up care

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2.1. Surgery/Inpatients Before you start to prepare any material please review: QEII — Pre Admission Clinic for Same Day Surgery (#0065) — Same Day Surgery Admission (#0671) HCH — Same Day Surgery Admission (#1050) These booklets thoroughly cover general preoperative care and the first few days after surgery. Content

Headings/Subheadings

• Brief introduction stating why surgery is being performed. • Anatomical explanation of surgery providing diagram. • Before surgery • Special preparation

• Some reasons why this surgery may be needed. • Your surgery • Getting ready • Just before surgery - Special tests - Special diet - Medicines • Your hospital stay QEII - Please read booklet Pre-Admission Clinic for SDS or Same Day Surgery Admission • HCH - Please read booklet Same Day Surgery Admission

• Care during hospitalization QEII - Only include topics not addressed in Pre-Admission Clinic for SDS (#0065), or Same Day Surgery Admission (#0671) • HCH - Only include topics not addressed in Same Day Surgery Admission (#1050) • Care at home

• • • •

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At home OR Recovering at home OR Active and involved again OR When you go home - Care of incision - Activity/Sexual activity - Exercise/Sports - Healthy eating - Your medicines - Supplies/Special equipment - Returning to work - Managing stress/Coping


Content

Headings/Subheadings

• Symptoms to report to physician • Follow-up

• Call your doctor if you have: • Visit to your doctor/other health care professionals • Staying healthy • Who can help me in the community?

• Risk factors to be avoided • Resources

2.2. Day Surgery/Outpatients Procedure General topics are covered in: QEII - After My Operation (#0064) HCH - After My Operation (#1052) Content

Headings/Subheadings

• Care at home

• • • • • •

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Controlling discomfort Hygiene Physical activity/Sexual activity Care of your incision Other important points Call your doctor if you have:


3. Medical Condition Content

Headings/Subheadings

• Briefly describe condition

• What is ______________? • What causes ___________?

• Is it inherited? • Symptoms of condition • What are the symptoms of _______? • How is ____________ diagnosed? • Recovery in-hospital • How is ______________ treated? Treatment: Life style/Staying healthy What can I do to help myself? - Stop smoking - Activity - Healthy eating - Managing stress • Side effects and risks of medications • Your medicines • Care at home • At home OR • Recovering at home Life style - Activity/Sexual activity - Exercise/Sports - Healthy eating - Your medicines - Supplies/Special equipment - Returning to work - Managing stress/Coping • Symptoms to report to physician • Call your doctor if you have: • Follow-up care • Visit to your doctor/other health care professionals • Other treatments • Resources • Who can help me in the community? • In many conditions it is not necessary to do recovery in-hospital and care at home separately.

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4. Health Promotion Content

Headings/Subheadings

• Changes in lifestyle required to reduce risk factors

• • • • • • •

• Resources

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Preventing _____________. OR Making some changes. OR Controlling risk factors. OR What can I do to feel better? OR Staying healthy. Who can help me in the community? Learn about support groups in your area by calling _______________.


Developing Print Material SMOG Readability Formula Our patients and their families must be able to read and understand our printed instructions. We must remember that many individuals read at least two grade levels below their last school grade completed (London, 1999, p189). A readability formula enables us to take a rough measure of the reading level of material but it is not a substitute for common sense as there are other considerations when preparing material. The fact that an item is written at a low reading level does not mean that it is clear and well written. Target the reading level for grade six or below. SMOG is only one of many formulas that can be used. SMOG was first published in G. Harry McLaughlin. (1969). SMOG grading: A new readability formula. Journal of Reading. 12 (8), 639-646.

SMOG for Text Containing More Than 30 Sentences: 1. Choose 10 consecutive sentences from near the beginning, middle and end of your text. Skip titles and headings. 2. In the sample of 30 sentences, count all words that have 3 or more syllables. Include repetitions of the same word, no matter how often it is used. 3. Find the nearest square root of this total. 4. Add 3 to the square root to find the reading level that a person must have reached to understand the text.

Additional Guidelines: • Hyphenated words are considered one word. • Numbers that are in numeric form should be pronounced to determine the number of syllables. • Abbreviations should be read as unabbreviated to determine the number of syllables. • If a sentence contains a colon, avoid using that sentence in your count, OR count it as two sentences. • Do not count verbs ending in “ed” or “es” that give the word a third syllable.

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SMOG Readability Calculator To use the Calculator, go to http://webpages.charter.net/ghal/SMOG.html The SMOG Calculator assesses an entire text, not just a sample. The SMOG Calculator was developed by G. Harry McLaughlin, Ph.D. in collaboration with Alain Trottier.

Flesch – Kincaid Reading Level To access Flesch-Kincaid reading level information in Microsoft Word: - click “Tools” on your standard toolbar - click “Options” - click “Spelling and Grammar” - under “Grammar” in the options box, check off “Show readability statistics” - click “OK”. Click on “Tools” in the Menu Bar and then select “Spelling and Grammar”. When the grammar check is completed, you will be provided with “Readability Statistics”.

Davis, Meldrum, Tippy, Weiss & Williams (1996, p. 114) make a very important point when they write that studies indicate even highly educated adults are not insulted by health material written in simplified language.

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Who is Responsible?

Maintenance and Review Process Need for print material identified.

Developer

Locate existing material.

Developer

Critique material using Check List for Developer, Form 1 (pgs. 12, 13).

Developer

Yes No further action required

Pamphlet meets criteria

Developer

No Purchase

Revise

Request for a minor revision of existing print material is to be submitted to the Patient Education Coordinator who will take the appropriate action. If major revisions, follow process for Develop new.

Develop new

Developer

Establish work-group

Developer

Contact the Patient Education Coordinator to avoid duplication of efforts and increase awareness of resources. Consult with the Patient Education Coordinator throughout the developmental process as required. Consult with other disciplines when appropriate.

Developer

Familiarize Developer with Patient/Family Education Print Material Guidelines if needed.

Patient Education Coordinator

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Maintenance and Review Process cont’d

Who is Responsible?

Refer to Criteria for Development (pgs. 5-8) in Patient/ Family Education Print Material Guidelines.

Developer

Prepare electronic draft of text.

Developer

Obtain and document clinical approval from appropriate stakeholders.

Developer

Use Check List for Developer, Form 1 (pgs. 12, 13).

Developer

Obtain feedback from someone who is unfamiliar with content area and adjust if needed.

Developer

No Pamphlet satisfactory

Rewrite and reevaluate

Developer

Yes Field test the draft to ensure the product works using Consumer’s Evaluation of Pamphlet, Form 3 (pgs. 26, 27). Feedback from 3 patients is adequate.

Rewrite and reevaluate

No

Pamphlet satisfactory

Developer

Developer

Yes

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Maintenance and Review Process cont’d Submit final electronic draft to the Patient Education Coordinator for approval as a teaching tool.

Recommend adjustments to Developer.

No

Pamphlet meets criteria

Who is Responsible? Developer

Patient Education Coordinator

Yes Consult with Graphic Designer if illustrations are required.

Patient Education Coordinator/Developer

Collaborate with the Graphic Designer who follows layout criteria in the development of the pamphlet.

Patient Education Coordinator

Assign Print Shop order number.

Graphic Designer

Send proof of pamphlet to Patient Education Coordinator.

Graphic Designer

Provide final approval following consultation with Developer.

Patient Education Coordinator

Sign Form 2 (pg. 25) and send to Patient Education Coordinator.

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Division Head/Clinical Leader or Delegate


Maintenance and Review Process cont’d

Who is Responsible?

Notify Developer when the pamphlet can be ordered from the Print Shop.

Patient Education Coordinator

Maintain a current paper copy (supplied monthly by Graphic Designer) of the pamphlet catalogue. Catalogue shows pamphlet number, development or revision date and owner (unit or department). Catalogue is updated on the Capital Health Intranet bi-monthly.

Patient Education Coordinator Graphic Designer Web Coordinator

Notify Developer 6 months prior to review date that pamphlet is to be evaluated.

Patient Education Coordinator

Review and update pamphlet every 3 years or more frequently if necessary.

Developer

Request Developer complete Evaluation of Collaboration with Patient Education Coordinator, Form 4 (pgs. 33, 34).

Patient Education Coordinator

Initiate process & ensure pamphlet is placed on Capital Health Public Website.

Patient Education Coordinator

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Developing Print Material Patient/Family Education Print Material Form 2 Approval Record for inhouse printing and Capital Health public website.

Title

Print Shop order #

I approve the patient education pamphlet(s) listed above to be provided in hard copy and placed on the Capital Health public website.

Approved by: Division Head/Clinical Leader or Delegate for Clinical Content

__________________________ Signature ___________________________ Print name Date: _____________________

Patient Education Coordinator for Patient Education Standards

__________________________ Signature Date: _____________________

Please sign and return to the CH Patient Education Coordinator. Rev June 2007 25


Developing Print Material Consumer’s Evaluation of Pamphlet Form 3 Title of Pamphlet ________________________________________________ Please help us to make this pamphlet better by taking a few minutes to fill out this form. 1. Was the pamphlet easy to read? Yes ❑ No ❑ 2. Were the drawings helpful? Yes ❑ No ❑ 3. Would more drawings be helpful? Yes ❑ What of? ______________________

No

4. What did you learn from the pamphlet? _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ 5. Was there any unnecessary information in the pamphlet? Yes ❑ No ❑ (over) 26


6. How would you change the pamphlet? _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ 7. Do you have any questions that we did not answer in the pamphlet? _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ 8. How do you think you will use this pamphlet? ❑ Read it once and throw away. ❑ Take home for later use. ❑ Will not use. 9. Please rate the pamphlet. Very Good ❑ Good

Fair ❑

Thank you for helping us!

Rev June 2007 27

Poor


Catalogue Maintenance (prepared in-house) • In collaboration with the graphic designer, Audio Visual Department, the Patient Education Coordinator will maintain a hard copy of the catalogue that includes all approved pamphlets developed in-house. • This catalogue contains the numbers required to order from the Print Shop. Some subjects are very specific and an individual should not have any problem identifying a particular area of interest; however, others are grouped in a broader classification and may require time to locate the topic.

Subject Classifications Arabic Breast Disease Cancer Care NS, Medication Sheets Cancer General Cardiovascular System Dartmouth General Hospital Dermatology Diagnostic Imaging Emergency Endocrine System Food and Nutrition French Gastrointestinal System Geriatrics Gynaecology Hants Community Hospital Hematology Hospitals, CH Infectious Disease Intensive Care Unit Medications

AR WS CC CG WG DG WR WN WA WK LC FF WI WT WP HC WH WX WC IC QV 28


Mental Health Musculoskeletal System Nephrology Nervous System Nursing Nursing Units Ophthalmology Oral Surgery Otolaryngology Pain Management Palliative Medicine Physiotherapy Respiratory South Shore Regional Hospital Staff Surgery Spanish Urogenital System

WM WE WQ WL WY WZ WW WU WV PM WD WB WF SS ST WO SP WJ

• The graphic designer, Audio Visual Department will provide the Patient Education Coordinator with an updated catalogue every month. A copy of the catalogue that includes the development date of each pamphlet is available from the Patient Education Coordinator (473-7835) on request. • This catalogue will be updated bi-monthly. • Go to Capital Health Intranet and click on For Employees, Quick Links, Booking & Ordering and Teaching Pamphlets Order Numbers.

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Catalogue Recommendations for Materials (from outside sources) 1. Collection of Materials The portfolio or department or clinic or nursing unit can collect all patient/family education pamphlets from outside sources presently in use. It is recommended that staff collaborate with individuals in other areas caring for patients with the same clinical problems; for example cardiology and respirology.

2. Initial review On examining: • Discard materials that are not being used. • Discard materials that have not been revised in the past 3 years. • Review for accuracy. • Do a reading level check. Contact Patient Education Coordinator for assistance if needed.

3. Develop inventory Place titles under the following major headings of subject classification on the preceding page. Using Template provided, record: - Title - Development or Revision Date - Source: Address and/or Phone Number - Reading Level - Comment on quality of material

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31

Development/ Source Revision Date

Readability Evaluation SMOG/Grade

___________________________________________________________________________________________________________

___________________________________________________________________________________________________________

___________________________________________________________________________________________________________

___________________________________________________________________________________________________________

___________________________________________________________________________________________________________

___________________________________________________________________________________________________________

___________________________________________________________________________________________________________

___________________________________________________________________________________________________________

___________________________________________________________________________________________________________

___________________________________________________________________________________________________________

Title

____________________________________________________________ Major Heading

Catalogue of Patient / Family Education Print Material from Outside Sources


CH Pamphlets on the CH Public Website Stevenson (2000) finds that over time, use of the Internet for health topics has grown dramatically. Health and medical information was the third most popular topic people searched for in 2000. Capital Health pamphlets are available on the intranet and the public website. This enables staff and the public to access our pamphlets with ease.

To locate a pamphlet Go to the Capital Health Intranet/select For Employees/Quick Links/Documents and click on Patient Teaching Pamphlets or www.cdha.nshealth.ca/Select Patient Information and click on Patient Information Pamphlets or http://library.cdha.nshealth.ca/chpamphlets/ Wilson, Racine, Tekieli & Williams (2003) write that the Internet had a higher mean readability level than 12th grade. The pamphlets developed at Capital Health are easier to read than much of the patient education material available on the Internet. The pamphlet Health Information on the Internet (WX85-0228) is available from the Print Shop or the web to assist the user to identify reliable websites. Staff members can also order “bookmarks� from the Print Shop to promote the website.

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Developing Print Material Evaluation of Collaboration with Patient Education Coordinator Form 4 You recently consulted the Patient Education Coordinator for assistance when you were creating or revising patient/family education print material. It would be appreciated if you would answer the following questions and return this form to: Secretary Patient & Family Learning Centre 4B, VG Site, QEII Was your request for assistance met promptly? Yes ❑ No ❑ Were the services of the Patient Education Coordinator helpful? Yes ❑ No ❑ Comments _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ Did you learn how to prepare better quality patient education materials during this collaboration? Yes ❑ No ❑ Did you use the Capital Health Patient/Family Education Print Material Guidelines? Yes ❑ No ❑ (over)

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Was it useful? Very ❑

Somewhat

Not at all

How would you improve Patient/Family Education Print Material Guidelines? _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ How could have the Patient Education Coordinator been more helpful to you? _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ Are you pleased with the teaching aid you developed? Very ❑ Somewhat ❑ Not at all

Thank you for your time. We believe we can provide a better service in the future based on the comments we receive from you and our other clients. Date

_____________________________

Signature ___________________________________ (Optional)

June 2007

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Reviewing and Updating Pamphlets • All patient/family education print materials are to be reviewed every 3 years. • The Patient Education Coordinator will notify the developer when a pamphlet needs to be evaluated, in January of the year it is to be reviewed. • A second notice will be sent in April if there has not been any response from the Developer. • On December 31st of that year, the Patient Education Coordinator will cancel the pamphlet if there has not been any response from the Developer.

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Keeping Patient/Family Pamphlet Print Materials Updated in Clinical Areas To provide patient/client safety, it is essential that all nursing units and other clinical areas have the most recent update of each pamphlet available. Commencing in 2007, the development date of each pamphlet was placed on the front cover to assist in identifying outdated materials. The Print Shop always provides the latest version. Prior masters are destroyed when a pamphlet is updated.

Follow these steps to ensure materials are current: 1. The clinical area is to delegate one staff person who is responsible to maintain the pamphlet rack. 2. The Nursing Unit Manager/Manager will receive the notice of updates quarterly. He/ she is responsible to provide the delegate with the updated list from the Patient Education Coordinator. 3. When the delegate receives the quarterly list of pamphlet updates prepared by the Patient Education Coordinator he/she will: • order new or revised pamphlets from the Print Shop. • discard all pamphlets that have been revised or deleted. The Print Shop will charge to replace these pamphlets. 4. If packets are made up in advance, they must be checked for outdated pamphlets with the quarterly update list provided by the Patient Education Coordinator. 5. Once a year, the delegate will use the pamphlet catalogue (which provides a development date) to check all pamphlets to ensure that only the most recent versions are available. 6. To reduce waste, it is recommended that pamphlets be ordered in small numbers. Print Shop will provide orders as small as 15. 7. Do not keep a large numbers of pamphlets in storage areas. 8. When a pamphlet is being updated, the Patient Education Coordinator is to notify the Print Shop. Staff in the Print Shop will provide smaller orders until the new master is available.

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Bibliography ABC Canada Literacy Foundation. (2005) International Adult Literacy and Skills Survey (IALSS). Report Summary. Toronto: The Foundation. Alspach, G. (2004). Communicating health information, an epidemic of the incomprehensible. Critical Care Nurse. 24 , 8-12. Davis, T., Meldrum, H., Tippy, P., Weiss, B. & Williams, M. (1996). How poor literacy leads to poor health care. Patient Care. 30(16), 94-127. Doak, L., Doak, C. & Meade, C. (1996). Strategies to improve cancer education materials. Oncology Nursing Forum. 23(8), 1305-1312. Doak, C.C., Doak, L.C. & Root, J.H. (1996). Teaching patients with low literacy skills. Philadelphia: Lippincott. Hanson Frost, M., Thompson, R., Boeding Thiemann, K. (1999) Importance of format and design in print patient information. Cancer Practice. 7(1), 22 -27. Harper, T., Hutchings, T., Wizowski, L (2006). Writing health information for patients and families. Hamilton, ON: Media Production Services, Printing , McMaster University. Laidlaw, J. (2000). Helping the public with cancer information. Cancer Care. Winter 2000, 11. London, F. (1999). No time to teach? A guide to patient and family education. Philadelphia: Lippincott. Mansour,L.E. & Dowse, R. (2003). Effect of pictograms on readability of patient information materials. The Annals of Pharmacotherapy. Vol 37, July/August, 1003-1009. McClune, T., Burton, A. K. & Waddell, G. (2003). Evaluation of an evidence based patient education booklet for management of whiplash associated disorders. Emergency Medicine Journal. 2003 (20), 514-517. 37


McLaughlin, G. Harry. (1969). SMOG grading: A new readability formula. Journal of Reading. 12(8), 639-646. Monsivais, D & Reynolds, A. (2003). Developing and evaluating patient education materials. The Journal of Continuing Education in Nursing. 34(4), 172-176. Moult, B., Franck, L.S. & Brady H. (2004). Ensuring quality information for patients: development and preliminary validation of a new instrument to improve the quality of written health care information. Health Expectations. 2004 (7), 165-175. Partin, M.R., Nelson, D., Radosevich, D, Nugent, S., Flood, A.B., Dillon, N., Holtzma, J.,Haas, M.,& Wilt, T.J. (2004). Randomized trial examining the effect of two prostate cancer screening education interventions on patient knowledge, preferences and behaviors. CGIM. August 2004, vol. 19, 835-82. Paul, C.L. & Redman, S. & Sanson - Fisher, R.W. (2003) Print material content and design: is it relevant to effectiveness? Health Education Research, Theory & Practice 18 (2), 181-190. Quirk, P.A. (2000). Screening for literacy and readability: implications for advanced practice nurse. Clinical Nurse Specialist. 14(1), 26-32. Rootman, I. (2006). Health literacy: where are the Canadian doctors? Canadian Medical Association Journal. 175 (6), 606 - 609. Stevenson K. (2000). General Social Survey, Housing, Family and Social Statistics Division, Statistics Canada. Wilson, F.L., Racine, E., Tekieli, V. & Williams, B. (2003). Literacy, readability and cultural barriers; critical factors to consider when educating older African Americans with anticoagulation therapy. Journal of Clinical Nursing 2003(12), 275-282.

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DevelopingPatientMaterials